A patient is admitted for acute renal failure and the nurse is monitoring their response to medications. Which pharmacokinetic principle does the nurse understand will most likely be affected in this patient?

Choice A reason: Atenolol is a beta blocker that lowers blood pressure and heart rate. The nurse should hold atenolol for this client because the client's heart rate is already low (52 beats per minute), and giving atenolol could cause bradycardia (slow heart rate), which can lead to dizziness, fainting, or heart failure. The nurse should notify the provider and monitor the client's vital signs and cardiac rhythm.

Choice B reason: Captopril is an ACE inhibitor that lowers blood pressure and prevents kidney damage. The nurse should not hold captopril for this client because the client's blood pressure is still high (138/90 mmHg), and captopril could help lower it to the target range. The nurse should administer captopril as prescribed and monitor the client's blood pressure and renal function.

Choice C reason: Warfarin is an anticoagulant that prevents blood clots and reduces the risk of stroke. The nurse should not hold warfarin for this client because the client's INR (a measure of blood clotting time) is within the therapeutic range (2.0 to 3.0), and warfarin could help prevent post-operative complications such as deep vein thrombosis or pulmonary embolism. The nurse should administer warfarin as prescribed and monitor the client's INR and bleeding signs.

Choice D reason: Glipizide is not a medication for this client. Glipizide is an oral hypoglycemic agent that lowers blood sugar levels in people with diabetes. This client does not have diabetes and does not need glipizide. The nurse should check the medication order and the client's medical history and clarify any discrepancies with the provider.

Choice A reason: This choice is correct because captopril is an angiotensin-converting enzyme (ACE) inhibitor that can cause fetal harm or death if used during pregnancy. Captopril can affect the development of the baby's kidneys, lungs, skull, and blood vessels. The nurse should advise the patient to use effective contraception while taking captopril and to inform the provider as soon as possible if she becomes pregnant or plans to become pregnant. The provider may switch the patient to a safer medication for blood pressure control during pregnancy.

Choice B reason: This choice is incorrect because facial swelling is a serious side effect of captopril that may indicate angioedema, a life-threatening allergic reaction that causes swelling of the face, lips, tongue, throat, or airway. The nurse should instruct the patient to stop taking captopril and seek emergency medical attention if she develops facial swelling or any signs of difficulty breathing, such as wheezing, stridor, or cyanosis. Reducing the dose of captopril will not prevent or treat angioedema.

Choice C reason: This choice is incorrect because captopril can be taken with or without food, depending on the patient's preference and tolerance. Food may decrease the absorption of captopril, but this effect is not clinically significant for most patients. The nurse should advise the patient to take captopril at the same time each day, preferably one hour before meals, to maintain consistent blood levels and effects.

Choice D reason: This choice is incorrect because captopril is unlikely to cause anaphylaxis, a severe and potentially fatal allergic reaction that involves multiple organ systems. Anaphylaxis can cause symptoms such as hives, itching, flushing, swelling, nausea, vomiting, diarrhea, abdominal pain, low blood pressure, fast heart rate, and shock. The nurse should instruct the patient to carry an epi pen only if she has a history of anaphylaxis or a severe allergy to another substance. .